NC IMMUNIZATION COALITION FLU THEN AND NOW NC DHHS COMMUNICABLE DISEASE BRANCH ANITA VALIANI, MPH AUGUST 1, 2018
OBJECTIVES I. 2017-18 Influenza Season Recap of the season nationally Influenza Burden Estimates from 2016-17 Final updates for NC II. Upcoming 2018-19 influenza Season New vaccine information Updates before the season starts
Nationally 2017-18 SEASON HOW DID IT END?
2017-18 SEASON Nationally, majority of the specimens tested were influenza A(H3N2) virus followed by influenza B(Yamagata lineage). Majority of lab confirmed influenza hospitalizations were due to heart disease, metabolic disorders, and obesity in adults. Long flu season; record-breaking hospitalizations ILI was above national baseline 19 weeks
2016-17 INFLUENZA BURDEN ESTIMATES CDC uses the estimates of the burden of influenza in the population and the impact of influenza vaccination to inform policy and communications related to influenza. 2016-17 was notable because of high hospitalization rates Vaccination prevented lowest proportion of illnesses among adults aged 18-49 years, had the lowest vaccine coverage; adults aged 65 years, had higher vaccine coverage but the lowest vaccine effectiveness. Vaccination prevented the greatest proportion of outcomes among children aged 6 months to 4 years and 5 to 17 years, where the burden of influenza illness and medical visits was high and the vaccine effectiveness was greatest. Improvements in vaccine coverage could provide a greater public health benefit. CDC estimates that influenza vaccination during the 2016 2017 influenza season prevented an estimated 5.29 million illnesses, 2.64 million medical visits, and 84,700 hospitalizations associated with influenza.
Table 5: Influenza Vaccine Coverage and Vaccine Effectiveness, by Age Group United States 2016-2017 Influenza Season Table 5: Influenza Vaccine Coverage and Vaccine Effectiveness, by Age Group United States 2016-2017 Influenza Season Age 6 months-4 years Vaccine coverage* Vaccine effectiveness % 95% CI % 95% CI 69.4 68.1-70.7 41 13-60 5-17 years 55.2 54.4-56.0 51 39-61 18-49 years 33.1 32.3-33.9 19 0-34 50-64 years 44.9 43.9-45.9 40 24-53 65 years 64.8 63.8-65.8 20-11-43 Overall 46.8 46.3-47.3 40 32-46
Table 3: Estimated Number and Fraction of Influenza Illnesses, Medical Visits, and Hospitalizations Averted by Vaccination, by Age Group United States, 2016 2017 Influenza Season Averted medical Age (yrs) Averted illnesses Averted hospitalizations visits No. 95% CI No. 95% CI No. 95% CI Fraction Prevented (%) 95% CI 6 months-4 602,000 160,000-1,130,000 403,000 107,000-758,000 4,200 1,120-7,850 23.8 7.5-35.6 5-17 1,920,000 1,320,000-2,700,000 999,000 680,000-1,400,000 5,270 3,630-7,400 23.8 17.8-29.2 18-49 527,000 32,000-1,010,000 195,000 11,800-371,000 2,960 180-5,660 5.6 0.4-10.0 50-64 1,640,000 926,000-2,380,000 703,000 393,000-1,040,000 17,300 9,820-25,200 15.6 9.3-20.5 65 604,000 0-1,470,000 338,000 0-839,000 54,900 0-134,000 11.5 0.0-23.6 All ages 5,290,000 3,910,000-7,000,000 2,640,000 1,940,000-3,500,000 84,700 26,100-167,000 12.4 4.1-21.3
2017-18 SEASON NC UPDATES In NC, ILI in outpatient settings was above baseline for 14 consecutive weeks Activity started to peak at the end of December 2017 Continued to see high activity until first week of April
2017-18 SEASON NC UPDATES Mainly Flu A(H3N2) circulated until March then Flu B activity picked up Total of 391 flu associated deaths occurred -- 7 pediatric deaths reported for NC 221 Females (57%) and 170 Males (43%) Vaccination status is known for 243 cases out of the 391 reported deaths; 166 (42%) were vaccinated; remaining 225 were unvaccinated or had no documentation of a flu vaccine. 309 (79%) received some antiviral treatment for their illness.
FLU ASSOCIATED DEATHS BY WEEK, 2017-18
2017-18 SEASON NC UPDATES Influenza outbreaks reported over the last 4 seasons- 2014-15: H3N2 predominant season 2015-16: H1N1 & B predominant season 2016-17: H3N2 predominant season 2017-18: H3N2 predominant season Flu Outbreaks 3% 20% 50% 2017-18 2016-17 2015-16 2014-15 27%
2018-19 FLU SEASON VACCINE SELECTION Northern Versus Southern Hemisphere Flu Vaccine Composition 2018-2019 2018-2019 Northern Hemisphere Flu Vaccines 2018 Southern Hemisphere Flu Vaccines Quadrivalent Trivalent Quadrivalent Trivalent (4-component) (3-component) (4-component) (3-component) A/Michigan/45/2015 (H1N1)pdm09-like A/Michigan/45/2015 (H1N1)pdm09-like A/Michigan/45/2015 (H1N1)pdm09-like A/Michigan/45/2015 (H1N1)pdm09-like A/Singapore/INFIMH-16-2019/2016 (H3N2)-like* B/Colorado/06/2017 (B/Victoria)* B/Phuket/3073/2013- like (B/Yamagata) A/Singapore/INFIMH- 16-2019/2016 (H3N2)- like* B/Colorado/06/2017 (B/Victoria)* A/Singapore/INFIMH-16-2019/2016 (H3N2)-like B/Brisbane/60/2008-like (B/Victoria) B/Phuket/3073/2013- like (B/Yamagata) A/Singapore/INFIMH-16-2019/2016 (H3N2)-like B/Phuket/3073/2013- like (B/Yamagata)
2018-19 NEW THIS SEASON.. New for the 2018-19 season, and different components in the flu vaccine since 2017-18 season are the A/Singapore/INFIMH- 16-2019/2016 (H3N2)-like and the B/Colorado/06/2017 (B/Victoria) ACIP reccommends for the 2018 19 U.S. influenza season, providers may choose to administer any licensed, ageappropriate influenza vaccine (IIV, recombinant influenza vaccine [RIV], or LAIV4). Intranasally administered live attenuated influenza vaccine (LAIV) is now an option for those it is appropriate for.
CURRENT FLU ACTIVITY Increased activity in South America Peak activity in Southern Africa Worldwide influenza A viruses are still the majority
CURRENT AND 2018-19 START..? What are we seeing? In the past several weeks we are seeing Flu A(H1N1) circulating nationally in very low numbers Seeing parainfluenza activity along the east coast and even here in NC Flu A is predominantly circulating in the southeastern US, again in very low numbers Lastly, we are seeing other outbreaks as well- lots of pertussis, some mumps, a measles, and now Hep A.
HEPATITIS A UPDATE
CONFIRMED OUTBREAK-ASSOCIATED CASES OF HEPATITIS A IN NORTH CAROLINA: JANUARY 1, 2018 JULY 26, 2018
QUESTIONS? THANK YOU